重症化慢性乙型肝炎患者进展为慢加急性肝衰竭预警模型的建立与验证

发布时间：2018-03-13 19:04

本文选题：重症化　切入点：慢性乙型肝炎　出处：《遵义医学院》2017年硕士论文　论文类型：学位论文

【摘要】：目的:建立并验证重症化慢性乙型肝炎(chronic hepatitis B,CHB)患者进展为慢加急性肝衰竭(acute on chronic liver failure,ACLF)的预警模型。方法:回顾性分析2011年1月至2017年2月遵义医学院附属医院感染科住院部收治的474例重症化慢性乙肝患者临床资料;随机将252例患者分为建模组,另外222例患者为验证组。单因素分析找出进展为ACLF的危险因素,进一步用Logistic回归法进行多因素分析找出独立危险因素,建立预警模型;用受试者工作特征(receiver operating characteristic,ROC)曲线及曲线下面积(area under the curve,AUC)评估预警模型并与终末期肝病(model for end-stage liver disease,MELD)、MELD-Na模型进行比较。结果:1.共筛选出符合纳入及排出标准的重症化CHB患者474例,其中男399例,女75例;发展为ACLF 36例,男28例,女8例,平均年龄43.33±10.29岁,未进展为ACLF患者438例,男371例,女67例,平均年龄37.68±11.26岁;2.单因素分析发现HBV DNA、谷氨酰转肽酶(gamma-glutamyl transpeptidase,GGT)、胆碱酯酶(cholinesterase,CHE)、血清总胆红素(total bilirubin,TBIL)、间接胆红素(indirect bilirubin,IBIL)、前白蛋白(prealbumin,PA)、凝血酶原时间(prothrombin time,PT)、活化部分凝血酶原时间(activated partial prothrombin time,APTT)、凝血酶原活动度(prothrombin activity,PTA)、国际标准化比值(international normalized ratio,INR)及尿酸(uric acid,UA)为重症化CHB患者进展为ACLF的危险因素;3.多因素Logistic回归分析发现HBV DNA、INR升高是重症化CHB患者发展为ACLF的独立危险因素,建立预警模型方程式=-14.049+0.687×lgHBV DNA+4.798×INR;4.在验证组中本研究预警模型的AUC(0.764)明显高于MELD(0.663)及MELD-Na(0.665),并且具有较高的敏感性(72.22%)、特异性(79.41%)和较好的阳性似然比(3.51)、阴性似然比(0.35),且阳性预测值(28.89%)明显高于MELD(11.61%)及MELD-Na(15.22%)。对重症化HBV感染者进展为ACLF有较好的诊断价值。结论:重症化CHB患者发展为ACLF的危险因素包括高血清水平HBV DNA、TBIL,低血清水平GGT、CHE、PA、UA及凝血功能障碍;其中HBV DNA和INR升高是其独立危险因素;建立的预警模型对重症化CHB患者进展为ACLF具有较好的预警作用。
[Abstract]:Objective: to establish and verify the early warning model of chronic hepatitis liver failure in patients with severe chronic hepatitis B. methods: from January 2011 to February 2017, the hospital affiliated to Zunyi Medical College was retrospectively analyzed. The clinical data of 474 patients with severe chronic hepatitis B in our hospital; 252 patients were randomly divided into two groups: the modeling group and the other 222 patients. The single factor analysis was used to find out the risk factors of progression to ACLF, and the Logistic regression method was used to find out the independent risk factors and establish the early warning model. The early warning model was evaluated with receiver operating character curve and area under the curve. The model was compared with that of for end-stage liver disease model and MELDLD-Na model of end-stage liver disease. Results 1. 474 severe CHB patients who met the criteria of inclusion and exclusion were selected. There were 399 males, 75 females, 36 patients with ACLF, 28 males and 8 females, with an average age of 43.33 卤10.29 years. The average age was 37.68 卤11.26 years old. Univariate analysis showed that HBV DNA, gamma-glutamyl transpeptidase (GGTN), cholinesterase cholinesterase (cholinesterase), total bilirubin (total bilirubin), indirect bilirubin (Tbilirubin), indirect bilirubin, prealbumin, prothrombin, prothrombin, activated partial prothrombin. Prothrombin activity, international normalized activity, and uric acid acidosis were risk factors for progression to ACLF in patients with severe CHB. Multivariate Logistic regression analysis showed that the increase of HBV ACLF was an independent risk factor for the development of ACLF in patients with severe CHB. In the validation group, the AUC 0.764) of the early-warning model was significantly higher than that of MELDD 0.663) and MELD-NaO0.6650.665.The equation was highly sensitive and specific 79.41), and the positive likelihood ratio was 3.51%, the negative likelihood ratio was 0.35%, and the positive predictive value was 0.35%, and the positive likelihood ratio was 3.51%, the negative likelihood ratio was 0.35%, and the positive predictive value was 0.35%, with a high sensitivity of 72.22% and a specificity of 79.41%. Conclusion: the risk factors for the progression of severe HBV infection to ACLF include high serum HBV DNA til, low serum GGT CHEPAUA and coagulation dysfunction. The risk factors for the progression to ACLF in patients with severe CHB are significantly higher than that of MELDD 11.61) and MELD-NaH15.220.Conclusion: the risk factors for the progression to ACLF in patients with severe CHB include high serum HBV DNA til, low serum GGTCHEPAUA and coagulation dysfunction. The elevation of HBV DNA and INR were independent risk factors, and the established early warning model had a good early warning effect on the progression of severe CHB patients to ACLF.
【学位授予单位】：遵义医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R512.62;R575.3

【相似文献】